Patient safety project underway

The Centers for Medicare & Medicaid Services' (CMS) 9th Scope of Work (9SOW) officially began on Aug. 1, 2008, and with it came the creation of the Patient Safety Theme. In an effort to address the growing concerns of both the public and medical professionals, CMS is charging its Quality Improvement Organization (QIO) contractors to work with nursing homes and hospitals to help them institute best practices in several areas that demonstrate a need for improvement:

• Surgical care infection
• Heart failure care
• MRSA
• Pressure ulcers in nursing homes and hospitals
• Physical restraint use
• Drug safety

Quality Insights of Delaware will work with select "Communities of Practice" (CoPs) on each of the measures in an effort to improve the quality of care and the level of patient safety delivered to all patients and residents. This is the first issue of Patient Safety Insights - a quarterly e-newsletter that will keep you up to date on the Patient Safety Theme projects.

This first issue outlines each area of focus, as named above. We hope you find this newsletter a valuable resource. Feel free to forward it to other staff members in your facility that may wish to subscribe.

A focus on and dedication to patient safety is becoming increasingly important in today's health care environment. Those that recognize that fact are even designing whole facilities around established patient safety best practices; case in point is Dublin Methodist Hospital, a part of OhioHealth.

Dublin Methodist opened its doors only eight short months ago, and already satisfaction scores for both the ED and the inpatient unit are consistently above the 95th percentile. Dublin Methodist was built for maximum patient safety. It uses advanced health care IT wherever possible, all patient rooms are acuity adaptable and like-handed, and healing elements like fresh air and natural light are available in nearly every corner of the building.

While not all facilities have the ability to re-build from the ground up, like Dublin Methodist, the practice of patient safety is something that can be learned and applied by all health care entities. We at Quality Insights look forward to working with Delaware's nursing homes and hospitals in this capacity over the next

CMS extends SCIP and heart failure work in the 9SOW

The Centers for Medicare & Medicaid Services (CMS) will continue its efforts to reduce surgical complications under the patient safety theme in the 9th Scope of Work (9SOW). The scope of the new national project has expanded and targets additional adverse events, including venous thromboembolic and cardiac complications. Safety in heart failure care was added with the inclusion of the use of ACE I and ARB in the treatment of left ventricular systolic dysfunction.

The aim of the SCIP/HF Project is to improve patient safety through education, training, regional collaboration, on-site consultations, and the use of improvement tools such as order sets. A meaningful reduction in complications and overall improvement requires that surgeons, anesthesiologists, perioperative nurses, pharmacists, infection prevention professionals and hospital executives work together to intensify their commitment to making surgical care improvement a priority.

Hospitals in the SCIP/HF Community of Practice (CoP) were identified by CMS as facilities that would benefit from the increased use of evidence-based care processes in an effort to make surgery safer and reduce adverse patient outcomes. To be chosen as a member of the CoP, executive commitment is required. Each hospital participating in this CoP will have access to all Quality Insights resources including on-site visits, consultations, intervention strategies and support for data analysis.

The priorities of Quality Insights' SCIP/HF initiative are aligned with CMS' Value Based Purchasing Plan, the Joint Commission's quality and safety goals and the Institute for Healthcare Improvement's (IHI) 5 Million Lives Campaign.

CMS adds MRSA reduction to 9SOW

The Centers for Medicare & Medicaid Services (CMS) has, for the first time, charged Quality Improvement Organizations (QIOs) with the task of reducing rates of health care-associated MRSA infections. Methicillin Resistant Staphylococcus Aureaus (MRSA) is the most common hospital-acquired infection in the United States, according to the Association for Professionals in Infection Control and Epidemiology (APIC), increasing patient morbidity, mortality and hospital costs.

The main goal of the project is to encourage hospitals to report MRSA cases to the National Healthcare Safety Network (NHSN) Multi-Drug Resistant Organism (MDRO) module in an effort to reduce infection and transmission rates within the hospital.

In August, Quality Insights began recruiting hospitals to participate in the MRSA Project. Quality Insights will work with hospitals to make an impact in reducing the rate of health care-associated MRSA infections by using the Institute for Healthcare Improvement's (IHI) recommended five components of care: hand hygiene, decontamination of the environment and equipment, active surveillance, contact precautions for infected and colonized patients, and device bundles (central line and ventilator).

Hospitals and nursing homes to work together

In the 9th Scope of Work (9SOW), hospitals and nursing homes will be expected to team up to reduce the incidence of pressure ulcers. The facilities selected for the project are from a Centers for Medicare & Medicaid Services (CMS)-generated target list of nursing homes with higher rates of pressure ulcers and a group of hospitals located in the same counties as the nursing homes.

CMS data for Q2 2007 reports a national pressure ulcer rate of greater than 12 percent in many nursing homes. In FY 2007, CMS reported the incidence of new pressure ulcers in hospitals to be around seven percent. The Institute for Healthcare Improvement (IHI) reports, "Each year nearly 1 million people develop pressure ulcers resulting in costs exceeding $1.3 billion dollars, and the human suffering is inestimable." Pressure ulcer prevention is an area of potential harm where there is evidence of effective measures to improve safety. However, effective implementation of these measures is often lacking in many nursing homes and hospitals.

The Pressure Ulcer Reduction Project is designed to educate providers and encourage the use of evidence-based methodology to prevent and treat pressure ulcers. Cross-setting efforts between nursing homes and hospitals will provide an opportunity for developing improvement programs collaboratively to achieve significant gains in the prevention of pressure ulcers and also reduce the cost involved in treatment.

Restraint reduction efforts will continue

The aim of the Restraint Reduction Project is to improve the safety of the nursing home residents through the reduction and elimination of physical restraints. The ultimate goal of the initiative is to reduce the restraint rate nationally by 20 percent by the year 2010. Partners in restraint reduction believe that a meaningful reduction requires the nursing home team work together to intensify its commitment to making restraint reduction and elimination a priority.

The nursing homes will be part of the Restraint Reduction Community of Practice (CoP), which is designed to educate providers and encourage the use of evidence-based methodology in restraint reduction. Each nursing home participating in the CoP will have access to all Quality Insights' resources including on-site visits, consultations, intervention strategies and support for data analysis. Homes participating will be able to collaborate with other nursing homes, be recognized as an early adopter and leader in quality improvement and recognized nationally as a CoP participant.

Drug safety project begins

The aim of the Drug Safety Project is to reduce drug on drug interactions (DDI) rates and potentially inappropriate medications (PIM) using a small community of practice that will include nursing homes, pharmacy providers, nursing home medical directors and consultant pharmacies. Community education will follow as the community identifies successes within best safety practices.

This material was prepared by Quality Insights of Delaware, the Medicare Quality Improvement Organization for Delaware, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.

Publication number 9SOW-DE-PASA08.32. App. 10/08.